Dr. Anthony S. Fauci, Director, US National Institute of Allergy and Infectious Disease (NIAID), and National Institutes of Health (NIS), was facilitated this evening at the ongoing PMWC 2021, by Dr. Leroy Hood, SVP and Chief Science Officer, Providence St. Joseph Health, Chief Strategy Officer, Co-founder, and Professor, Institute for Systems Biology (ISB), and Co-Program Chair, PMWC 2021. Dr. Fauci was presented the luminary award.
Dr. Fauci was appointed Director of NIAID in 1984. He has served as a relentless crusader for some of humanity’s most virulent medical threats. He has advised six Presidents on HIV/AIDS. He oversees an extensive research portfolio of basic and applied research to prevent, diagnose, and treat established infectious diseases such as HIV/AIDS, respiratory infections, diarrheal diseases, tuberculosis and malaria as well as emerging diseases such as Ebola, Zika and now, Covid-19.
Dr. Fauci said it is a great honour to receive this award from Dr. Hood. He also recalled in 1968, where, there was a Journal Club. Dr. Fauci was invited to join the club by Dr. Hood.
Covid-19 challenge and benefits
Dr. Fauci added that one of the clear things was how we showed the investment in vaccine technologies and pathogens, to go from the availability of a sequence, to a vaccine going to the arms of patients in 11 months. So many people do research. People were talking about vaccine all along. People thought it was a gap
Dr. Fauci spoke about the need for unity throughout this pandemic. He said: “This requires unity because we are all in this together. When wearing a mask becomes a political statement that is antithetical to combating a pandemic. We have a reasonable chance of crushing Covid-19 like we did with polio, measles and smallpox, but it will require global collaboration. It can’t be a thing that only rich countries get vaccinated.”
For the future, if we are able to remember the lessons, we would do well. We will have the capabilities to respond better. Go back a few years. SARS-Covi had happened in 2002. The time has come to develop a universal coronavirus vaccine. We have a very efficacious vaccine, which helps people by about 94-95 percent to get better. The efficacy level has remained constant. When this is over, we need to have a commission, and look at what we can do about the future problems.
Dr. Hood next asked about the RNA approach. Dr. Fauci said there are three platforms for Covid-19. One is RNA. If you need to change it, that’s very simple, as you need to pull it out. The idea that you can do with mRNA is better. Some vaccines are problematic, such as HIV, cancer, malaria. Messenger RNA (mRNA) is a single-stranded RNA molecule that is complementary to one of the DNA strands of a gene.
Pathogen sites can be a target. We were doing work on RSV. Respiratory syncytial virus (RSV) causes infections of the lungs and respiratory tract. It is so common that most children have been infected with the virus by the age of 2. Respiratory syncytial (sin-SISH-ul) virus can also infect adults. We were looking at the stabilized primer of the HIV. It was unstable. It took 2-1/2 years for the right mutations to stabilize.
Dr. Hood said that with cancer, people have long sought vaccines. What is the possibility with cancer tumors to make RNA vaccines for them? Dr. Fauci replied that these are exciting possibilities. The mRNA was really good for the efficacy. People were thinking more new stuff will be coming along.
Dr. Hood next asked: if you just have one shot of the vaccine, how good is that protection going to be? Dr. Fauci said that Moderna and Pfizer RNA showed that the optimum response gave 50 percent protection. If you have a gap between two shots, you get a 10-fold increase in protection. There is a prime, and a boost. There is a single-shot vaccine that is being tested in USA, Africa, etc. Once that is available, it will help.
Immunity does not last forever!
However, Dr. Fauci does not know how long will the vaccine prevent against Covid-19. The immunity does not last forever! When you are vaccinated, you get an open response. It will be probably for a longer duration. We need to get a substantial proportion of the world vaccinated. We will then develop a degree of herd immunity. There will be few susceptible hosts in the community. However, we are not going to crush it, unless you have a multi-year global vaccination campaign going.
With Moderna, the antibodies were said to be six times less effective. Dr. Fauci said there are two lineages of the vaccine — one in the UK, and one in South Africa. It does have a factor of transmissibility. The cushion of efficacy for the vaccines against the South Africa strain is high enough. Moderna is starting to make variants, along with the booster. They are testing for safety and immunity. We only talk about antibodies. These vaccines do induce immunogens for CD4 or CD8.
An immunogen is any antigen capable of inducing humoral and/or cell-mediated immune response, rather than immunological tolerance. This ability is called immunogenicity.
A normal CD4/CD8 ratio is greater than 1.0, with CD4 lymphocytes ranging from 500 to 1200/mm3, and CD8 lymphocytes ranging from 150 to 1000/mm3. If your ratio is higher than 1, it means your immune system is strong, and you may not have HIV. You may get HIV/AIDS if your CD4 count is less than 200/mm.
A CD4/CD8 ratio is considered normal when the value is between 1.0 and 4.0. In a healthy individual, that translates to roughly 30 to 60 percent CD4 T-cells in relationship to 10-30 percent CD8 T-cells. He added that there are new single-cell technologies. There are lot of labs who are developing those.
Antivirals and their effectiveness
Next, what about the antivirals? How effective are they? Dr. Fauci said there is no data available so far. In HIV, you drop the virus, and you get better. We are not yet sure with Covid-19. The treatment is hospitalized patients with oxygen. There are variable results with other studies. There are IL6 receptors, etc., that seem to have an impact.
Anti-IL-6 receptor antibodies are used in the treatment of Coronavirus-associated pulmonary pathology. During the global SARS-CoV-2 pandemic (2019-2020), antagonistic antibodies against the IL6 receptors were tested in clinical trials to assess their use in treating or preventing severe pneumonia in critically ill Covid-19 patients. We need to have drugs that can be given early on. You need to develop better antibody response.
Further, does aging alone increase risk? Dr. Fauci said that yes, it can be a problem. Age alone is an individual factor. Obesity is a prominent factor for high-risk diseases. People in the minority group are also open to getting infected due to the nature of the jobs that they do. You can stay generic. With obesity, it is a mechanical issue. There is a problem with the free flow of the diaphragm. The difference between races is miniscule. It is dependant on the social determinants of health, that create co-morbidities.
The British probably do many more sequence surveillance than the USA does. We need to do that, as well. The CDC has put together a consortium called SPHERES. The consortium includes 37 state and local public health laboratories, several large regional and national clinical diagnostic corporations, and academic and non-profit leaders, in pathogen genomics, bioinformatics, and public health from across the country. This consortium collects genomics-related data. We have to do comprehensive sequencing to know much more about the African strain.
It is a real phenomena, for those with symptoms of disease. After they clear the virus, they are RT-PCR compliant. There are variable degrees of symptoms that are common, such as fatigue, muscle ache, brain fog, etc. People get upset when you say that.
Dr. Fauci further added that we need to develop large cohorts. We also need to find the symptoms. We need to find any inflammatory markers, etc. We need to look at these, and other things clinically. We are going to ask the Congress for resources, for cohorts for the other diseases. The single-cell analysis will be transformational in the future.
Next, can we get things under control? He added that we have to get as many people vaccinated, as quickly as possible. We are certainly going to get variants. A multi-varient vaccine can help us crush this disease. The world has to pull together. We need to have co-operation, collaboration, and solidarity. The virus will continue to evolve with countries who are not able to clear it rapidly. The virus will mutate. There will be highly suppressed population.
Dr. Fauci said that back in February 2020, he had to contradict policies of the previous administration. N=1 is not a scientific process, it is an observation. To have a serious historic outbreak occur, when there is political divide in the country, is not a good thing. One, we needed to own the problem, back in 2020. We needed to double down, and it is a serious situation. On working with the previous administration, Dr. Fauci said, “I took no pleasure in having to contradict an administration, but I had to do that early on, because we saw discussions around anecdotes instead of science.”
He added: “The first thing we have to do is we have to get as many people vaccinated as quickly as possible to shut off these ridiculous numbers. “The virus is continuously to evolve and if you give the virus an extra few days in a host it will mutate to survive – the immune system is going to push the virus to mutate.”
Every country in the world has been hurt badly, since then. The federal government should not fix local problems, and the local governments should not be left on their own. The virus does not care about the border between the different states. People should also not avoid mask wearing, and doing congregations and gatherings.
He added that the WHO was delighted that the USA had returned to its fold. Today, USA is really very concerned about the virus. Public health messages are now going out. Let’s not be so divisive that we now let a viral enemy win this war. It is an enormous challenge for the country. We are now facing a grand challenge.
If someone close were to fall ill, we will need to get the vaccine that attacks the virus early. We can get him or her dexamethasone, probably. It was tested in hospitalized patients with Covid-19 in the United Kingdom’s national clinical trial RECOVERY, and was found to have benefits for critically ill patients. Sometimes, putting patients on the ventilator could be the worst thing that you do.
Finally, there are some gaps in the education for infectious disease. There should be greater interest among the students, interns and residents. We are not spending enough time on the infectious diseases.
On a personal note, may I take this opportunity to thank Dr. Lee Hood for inviting me to this great conference. It was an absolute pleasure listening to and covering Dr. Anthony Fauci.